DESCRIPTION (provided by investigator): Pediatric overweight (PO) is considered to have reached epidemic proportions, and its treatment is a high public health priority in light of the significant risk for development into adult obesity. Treatment studies of PO indicate that parental involvement is key in the acute and long-term reduction of PO. However, data are fragmented with regard to the intensity and quality of parental intervention as a function of developmental stage, and there are minimal data to inform best practice guidelines for overweight adolescents in particular. It is also essential to reduce barriers to care by developing a protocol that can be administered at the front-lines, with strong translational capabilities to pediatric medicine settings. The specific aims of this Exploratory/Developmental (R21) grant, which is submitted in response to PA 06-530, Parenting Capacities and Health Outcomes in Youths and Adolescents, are: 1. To develop a parent focused intervention for PO that addresses the unique needs of adolescents and modifies parenting practices in a developmentally sensitive manner to (a) reduce parent-driven risk factors for persistence or increase of overweight in adolescent offspring, (b) increase parent-driven factors protective against PO or continued increase in overweight, and (c) alter adolescent behaviors correlated with PO. This intervention represents an innovative adaptation of an established, efficacious family-based treatment (FBT) for adolescent eating disorders that enlists parents as the primary agents of symptom management during the acute stages of illness. Inherent in the original FBT model is a mission to increase parental competence and efficacy in facilitating healthy behaviors and outcomes for offspring. Beyond this, FBT provides a strong foundation for application to the significant problem of PO because of its attention to parental engagement strategies, its demonstrated efficacy in correcting maladaptive eating and related behaviors, its explicit agenda of blame reduction, its disease-based model, and its emphasis on promoting normal physical and psychosocial development. Moreover, this intervention is designed to be administered in either specialty clinics or pediatric primary care venues with culturally and socioeconomically diverse populations. We will refine FBT-PO via an iterative treatment development process that will have the greatest likelihood of not only clinical efficacy, but acceptability to patients and providers upon dissemination efforts. 2. To test the feasibility, acceptability, and efficacy of FBT-PO in a pilot randomized controlled trial (RCT) comparing FBT-PO to a nutritional education control (NEC) condition with 80 overweight adolescents and their parents or guardians. Treatment will be administered at pediatric and specialty clinics across two sites. The dual goal of this pilot RCT is to provide a venue to refine the intervention via an iterative feedback process, while generating feasibility data to design a future full-scale RCT via an R01 grant mechanism. Our primary outcome measure is change in BMI Z-score, and our primary hypothesis is that FBT-PO will be superior to NEC in reducing BMI Z-score. PUBLIC HEALTH RELEVANCE: Pediatric overweight (PO) is considered to have reached epidemic proportions, and its treatment is a high public health priority. PO poses significant risk for development into adult obesity, with corresponding liabilities in the medical and psychosocial domains. This project will yield the first intervention for PO that directly targets parenting practices known to be associated with overweight status in adolescents and accomplishes this in a developmentally sensitive manner during the high-risk period of adolescence.